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Phase 3a medicine > Paediatric - MSK > Flashcards

Paediatric - MSK Flashcards

1
Q

Name 3 Sx for presentation of JIA (Juvenile Idiopathic Arthritis)

A

Persistent swelling; joint stiffness (morning); joint pain; joint deformity; joint warmth; colour change; ROM loss

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2
Q

How many joints might be involved in Oligoarticular JIA and which joint is most commonly affected?

A

≤4 joints and 56% involve knee

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3
Q

First line antibiotic for osteomyelitis

A

Cefuroxime

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4
Q

Name a common cause of limp in children <4 year old

A

Toddler’s fracture (tibia) / Osteomyelitis / Arthritis / Malignancy

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5
Q

Name a common cause of limp in children 4-10 years old

A

Fracture / Osteomyelitis / Osteochondritis / Discoid Meniscus / Arthritis

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6
Q

Name a common cause of limp in children >10 years old

A

Stress fracture / Osteomyelitis / Osgood-schlatter / SCFE / Arthritis / Osteochondritis / Chondromalacia / Tarsal navicular or coalition

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7
Q

What are the most commonly affected joints for Septic Arthritis?

A

Hip, Knee and Ankle

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8
Q

Name 2 symptoms/signs of septic arthritis

A

Symptoms: joint pain, limp, fever, lethargy
Signs: swollen, red joint, only minimal movement of the affected joint is possible

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9
Q

Name an investigation for Septic Arthritis

A

joint aspiration, FBC - raised inflammatory markers, blood cultures

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10
Q

What are the 4 Kocher criteria for the diagnosis of septic arthritis?

A

fever >38.5 degrees C
non-weight bearing
raised ESR
raised WCC

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11
Q

What movement is reduced/lost in Slipped Capital Femoral Epiphysis and what is the major risk factor?

A

Internal rotation and Obesity

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12
Q

How might Slipped Capital Femoral Epiphysis present (Acute vs Chronic)?

A

Acute:
- Presents within three weeks of onset of symptoms
- Severe pain - the child is unable to walk or stand.
- Alterations in gait, limp on the affected side/external rotation of the leg and trunk shift.
- Hip motion is limited, especially internal rotation and abduction, due to pain.
- Obligate external hip rotation
(Drehmann’s sign: supine and the hip is passively flexed and then falls back into external rotation and abduction)

Chronic:
- Present more than three weeks after onset of symptoms.
- Mild symptoms with the child able to walk with altered gait.
- External rotation of the leg during walking. Range of motion of the hip shows reduced internal rotation with additional external rotation.
- When flexed up, the hip tends to move in an externally rotated position
- Mild-to-moderate shortening of the affected leg.
Atrophy of the thigh muscle may be noted.

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13
Q

Investigations for Slipped Capital Femoral Epiphysis

A
  • Anteroposterior and ‘frog-leg’ lateral X-rays show widening of epiphyseal line or displacement of the femoral head
  • globular swelling of the joint capsule, irregular widening of the epiphyseal line and decalcification of the epiphyseal border of the metaphysis
  • Epiphysis normally extends slightly cephalad to the upper border of the femoral neck.
  • Small amounts of slippage can be detected by the epiphyseal edge becoming flush with the superior border of the neck.
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14
Q

Complications of Slipped Capital Femoral Epiphysis

A
  • Chondrolysis (degeneration of the articular cartilage)
  • Avascular necrosis (AVN) of the epiphysis
  • Recurrence or progression
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15
Q

Name 2 major criteria for Rheumatic Fever on the Jones Criteria

A

Arthritis, Carditis, Chorea, Subcutaneous nodules, Erythema Marginatum
(minor criteria: fever, ^CRP+ESR, Arthralgia, Prolonged PR interval)

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16
Q

Name 2 investigations for Rheumatic Fever

A

Throat swab, Antibody testing (ASO or anti-DNaseB), ECG (prolonged PR interval), CXR (HF)

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17
Q

Name some causes of acute limp

A

Transient synovitis:

  • Acute onset
  • Usually accompanies viral infections, but the child is well or has a mild fever
  • More common in boys, aged 2-12 years

Septic arthritis/osteomyelitis
- Unwell child, high fever

Juvenile idiopathic arthritis
- Limp may be painless

Trauma
- History is usually diagnostic

Development dysplasia of the hip

  • Usually detected in neonates
  • 6 times more common in girls

Perthes disease

  • More common at 4-8 years
  • Due to avascular necrosis of the femoral head

Slipped upper femoral epiphysis

  • 10-15 years
  • Displacement of the femoral head epiphysis postero-inferiorly
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18
Q

What would be the most appropriate management for a child < 3 years presenting to GP with an acute limp?

A

Urgent Hospital assessment

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19
Q

Perthes disease is caused by avascular necrosis of the femoral head and presents with what 3 features?

A
  • hip pain: develops progressively over a few weeks
  • limp
  • stiffness and reduced range of hip movement
  • x-ray: early changes include widening of joint space, later changes include decreased femoral head size/flattening
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20
Q

Osgood-Schlatter disease is a type of osteochondrosis caused by inflammation (apophysitis) at which bony prominence?

A

Tibial Tuberosity

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21
Q

What hip movement is usually limited in Slipped Upper Femoral Epiphysis

A

Internal Rotation

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22
Q

Osteogenesis Imperfecta is also known as what?

A

Brittle bone syndrome

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23
Q

Osteogenesis Imperfecta is caused by genetic mutations that affect the formation of what protein?

A

Collagen

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24
Q

Features of Osteogenesis Imperfecta

A
  • Hypermobility
  • Blue / grey sclera (the “whites” of the eyes)
  • Triangular face
  • Short stature
  • Deafness from early adulthood
  • Dental problems, particularly with formation of teeth
  • Bone deformities, such as bowed legs and scoliosis
  • Joint and bone pain

TIP: Blue sclera is the key feature that appears in exams The exam patient may be a young child with unusual and recurrent fractures that would normally make you consider safeguarding, however “you notice a blue discolouration to the sclera”.

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25
Q

What are 2 pharmacological treatments for Osteogenesis Imperfecta?

A

Vit D and Bisphosphonates

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26
Q

In adults the same pathophysiology of Rickets leads to a condition called what?

A

Osteomalacia

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27
Q

What is the cause of Rickets?

A

Vit D or Calcium deficiency

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28
Q

Features of vitamin D deficiency and rickets

A

Patients with vitamin D deficiency and rickets may not have any symptoms. Potential symptoms are:

  • Lethargy
  • Bone pain
  • Swollen wrists
  • Bone deformity
  • Poor growth
  • Dental problems
  • Muscle weakness
  • Pathological or abnormal fractures

Bone deformities that can occur in rickets include:

  • Bowing of the legs, where the legs curve outwards
  • Knock knees, where the legs curve inwards
  • Rachitic rosary, where the ends of the ribs expand at the costochondral junctions, causing lumps along the chest
  • Craniotabes, which is a soft skull, with delayed closure of the sutures and frontal bossing
  • Delayed teeth with under-development of the enamel

TIP: Patients with rickets/vit D deficiency are likely to have risk factors such as darker skin, low exposure to sunlight, live in colder climates and spend the majority of their time indoors.

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29
Q

What is the laboratory investigation for vitamin D

A

Serum 25-hydroxyvitamin D

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30
Q

Are breast fed babies or formula fed babies more at risk of vitamin D deficiency?

A

Breast fed (formula feed is fortified with vitamin D)

31
Q

What is the most common cause of hip pain in children aged 3 – 10 years?

A

Transient Synovitis

32
Q

What can Transient Synovitis often be preceded by?

A

often associated with a recent viral upper respiratory tract infection

33
Q

Features of Transient Synovitis

A
  • Limp
  • Refusal to weight bear
  • Groin or hip pain
  • Mild low grade temperature

Children with transient synovitis should be otherwise well.

34
Q

How long is Transient Synovitis usually a problem + what is the chance of recurrence?

A
  • Significant improvement in symptoms after 24 – 48 hours.
  • Symptoms fully resolve within 1 – 2 weeks without any lasting problems.
  • Transient synovitis may recur in around 20% of patients.
35
Q

Septic Arthritis is most common in children under what age?

A

Under 4 years

36
Q

Features of Septic Arthritis

A
  • Hot, red, swollen and painful joint
  • Refusing to weight bear
  • Stiffness and reduced range of motion
  • Systemic symptoms such as fever, lethargy and sepsis
  • Septic arthritis can be subtle in young children, so always consider it as a differential when a child is presenting with joint problems.
37
Q

What is the most common causative organism of Septic Arthritis?

A

Staphylococcus Aureus

38
Q

First investigation for Septic Arthritis?

A

Joint Aspiration - Send the sample for gram staining, crystal microscopy, culture and antibiotic sensitivities

39
Q

What is the most common causative organism of Osteomyelitis?

A

Staphylococcus Aureus

40
Q

Where exactly is the infection in Osteomyelitis?

A

In the metaphysis of long bones

41
Q

Osteomyelitis is most common under what age?

A

Under 10 years

42
Q

Risk factors for developing Osteomyelitis

A
  • Open bone fracture
  • Orthopaedic surgery
  • Immunocompromised
  • Sickle cell anaemia
  • HIV
  • Tuberculosis
43
Q

Features of Osteomyelitis

A
  • Refusing to use the limb or weight bear
  • Pain
  • Swelling
  • Tenderness
44
Q

Initial investigation of Osteomyelitis

A

X-ray/MRI

45
Q

What age does Perthes’ Disease occur?

A

4-12 years (mostly 5-8 years)

46
Q

Perthes disease involves disruption of blood flow to where? (+ what is this called?)

A

Femoral head (Avascular necrosis)

47
Q

If the pain is triggered by minor trauma, what condition should you be thinking about?

A

slipped upper femoral epiphysis

48
Q

initial investigation of choice in Perthes disease

A

X-ray

49
Q

Treatment options for Perthes’ Disease

A
  • Bed rest
  • Traction
  • Crutches
  • Analgesia
  • Physiotherapy is used to retain the range of movement in the muscles and joints without putting excess stress on the bone.
50
Q

Talipes is also known as what?

A

Club foot

51
Q

What is first-line treatment for Talipes? (+ what does it involve?)

A

Ponseti Method

foot is manipulated towards a normal position and a cast is applied to hold it in position

52
Q

What age is Slipped Upper Femoral Epiphysis most common? (+ in what patient)

A

8-15 years (Obese)

53
Q

What movement is restricted in SUFE?

A

Internal Rotation

54
Q

Features of SUFE

A
  • Hip, groin, thigh or knee pain
  • Restricted range of hip movement
  • Painful limp
  • Restricted movement in the hip

(Suspect SUFE if the pain is disproportionate to the severity of the trauma)

55
Q

initial investigation of choice in SUFE

A

X-ray

56
Q

Osgood-Schlatter’s is caused by inflammation where?

A

Tibial tuberosity

57
Q

At what age does Osgood-Schlatter’s usually present?

A

10 – 15 years

58
Q

Is Osgood-Schlatter’s usually unilateral or bilateral?

A

Unilateral

59
Q

What tendon inserts into the tibial tuberosity?

A

Patella tendon

60
Q

What is a rare complication of Osgood Schlatters?

A

Full avulsion fracture, where the tibial tuberosity is separated from the rest of the tibia. This usually requires surgical intervention.

61
Q

Developmental dysplasia of the hip causes tendency for which 2 injuries?

A

Dislocation and subluxation

62
Q

Risk Factors for developmental dysplasia of the hip

A
  • First degree family history
  • Breech presentation from 36 weeks onwards
  • Breech presentation at birth if 28 weeks onwards
  • Multiple pregnancy
63
Q

Features of Developmental Dysplasia of the hip and the 2 diagnostic tests?

A
  • Different leg lengths
  • Restricted hip abduction on one side
  • Significant bilateral restriction in abduction
  • Difference in the knee level when the hips are flexed
  • Clunking of the hips on special tests

Ortolani test is done with the baby on their back with the hips and knees flexed. Palms are placed on the baby’s knees. Abduct the hips and apply pressure behind the legs with the fingers to see if the hips will dislocate anteriorly.

Barlow test is done with the hips adducted and flexed at 90 degrees and knees bent at 90 degrees. Gentle downward pressure is placed on knees through femur to see if the femoral head will dislocate posteriorly.

64
Q

What is the investigation of choice when children are suspected of having DDH?

A

Ultrasound of the hip

65
Q

First line treatment for DDH?

A

Pavlik harness

66
Q

Pavlik harness keeps the baby’s hips in what position?

A

harness keeps the baby’s hips flexed and abducted

67
Q

How long for a Pavlik harness to work?

A

6-8 weeks

68
Q

What cast is used after DDH surgery?

A

A Hip spica cast

69
Q

Juvenile idiopathic arthritis (JIA) is defined as joint inflammation presenting in children under what age?

A

Under 16 years

70
Q

What is the most common type of JIA?

A

Oligoarticular JIA (50% of JIA)

71
Q

Name a feature of Juvenile Psoriatic Arthritis (other than arthritis + Psoriasis)

A
  • Dactylitis.
  • Nail pitting or onycholysis.
  • Psoriasis in a first-degree relative.
  • It affects females twice as commonly as males, with mean age of onset 6 years.
  • Asymmetrical arthritis affecting small and large joints.
  • In over 50% arthritis occurs before psoriasis.
72
Q

Name an autoimmune test for JIA

A

ANA (antinuclear antibodies)
Rf (Rheumatoid Factor)
HLAB27

73
Q

What drugs can be given for JIA?

A

NSAIDs, steroids, Methotrexate, Tocilizumab, Sulfasalazine

74
Q

Symptoms of rheumatic fever occur how long after a sore throat?

A

1-5 weeks after

Phase 3a medicine (24 decks)

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